Felipe J S Jones1, Jason R Smith2, Neishay Ayub2, Susan T Herman2, Jeffrey R Buchhalter2, Brandy E Fureman2, Sydney S Cash2, Daniel B Hoch2, Lidia M V R Moura2. 1. From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD. felipe.jones@mgh.harvard.edu. 2. From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD.
Abstract
OBJECTIVE: To incorporate standardized documentation into an epilepsy clinic and to use these standardized data to compare patients' perception of epilepsy diagnosis to provider documentation. METHODS: Using quality improvement methodology, we implemented interventions to increase documentation of epilepsy diagnosis, seizure frequency, and type from 49.8% to 70% of adult nonemployee patients seen by 6 providers over 5 months of routine clinical care. The main intervention consisted of an interactive SmartPhrase that mirrored a documentation template developed by the Epilepsy Learning Healthcare System. We assessed the weekly proportion of complete SmartPhrases among eligible patient encounters with a statistical process control chart. We used a subset of patients with established epilepsy care linked to existing patient-reported survey data to examine the proportion of patient-to-provider agreement on epilepsy diagnosis (yes vs no/unsure). We also examined sociodemographic and clinical characteristics of patients who disagreed vs agreed with provider's documentation of epilepsy diagnosis. RESULTS: The median SmartPhrase weekly completion rate was 78%. Established patients disagreed with providers with respect to epilepsy diagnosis in 18.5% of encounters (κ = 0.13), indicating that they did not have or were unsure if they had epilepsy despite having a provider-documented epilepsy diagnosis. Patients who disagreed with providers were similar to those who agreed with respect to age, sex, ethnicity, marital status, seizure frequency, type, and other quality-of-life measures. CONCLUSION: This project supports the feasibility of implementing standardized documentation of data relevant to epilepsy care in a tertiary epilepsy clinic and highlights an opportunity for improvement in patient-provider communication.
OBJECTIVE: To incorporate standardized documentation into an epilepsy clinic and to use these standardized data to compare patients' perception of epilepsy diagnosis to provider documentation. METHODS: Using quality improvement methodology, we implemented interventions to increase documentation of epilepsy diagnosis, seizure frequency, and type from 49.8% to 70% of adult nonemployee patients seen by 6 providers over 5 months of routine clinical care. The main intervention consisted of an interactive SmartPhrase that mirrored a documentation template developed by the Epilepsy Learning Healthcare System. We assessed the weekly proportion of complete SmartPhrases among eligible patient encounters with a statistical process control chart. We used a subset of patients with established epilepsy care linked to existing patient-reported survey data to examine the proportion of patient-to-provider agreement on epilepsy diagnosis (yes vs no/unsure). We also examined sociodemographic and clinical characteristics of patients who disagreed vs agreed with provider's documentation of epilepsy diagnosis. RESULTS: The median SmartPhrase weekly completion rate was 78%. Established patients disagreed with providers with respect to epilepsy diagnosis in 18.5% of encounters (κ = 0.13), indicating that they did not have or were unsure if they had epilepsy despite having a provider-documented epilepsy diagnosis. Patients who disagreed with providers were similar to those who agreed with respect to age, sex, ethnicity, marital status, seizure frequency, type, and other quality-of-life measures. CONCLUSION: This project supports the feasibility of implementing standardized documentation of data relevant to epilepsy care in a tertiary epilepsy clinic and highlights an opportunity for improvement in patient-provider communication.
Authors: Lidia M V R Moura; Thiago S Carneiro; Andrew J Cole; John Hsu; Barbara G Vickrey; Daniel B Hoch Journal: Patient Prefer Adherence Date: 2016-10-31 Impact factor: 2.711
Authors: Anup D Patel; Christine Baca; Gary Franklin; Susan T Herman; Inna Hughes; Lisa Meunier; Lidia M V R Moura; Heidi Munger Clary; Brandy Parker-McFadden; Mary Jo Pugh; Rebecca J Schultz; Marianna V Spanaki; Amy Bennett; S Andrew Josephson Journal: Neurology Date: 2018-10-03 Impact factor: 9.910